Effect of Institutional Case Volume on In-Hospital and Long-Term Mortality in Critically Ill Patients Requiring Mechanical Ventilation for 48 Hours or More

Lee, Hannah; Choi, Sang June; Jang, Eun Jin; Kim, Dalho; Yoo, Seokha; Oh, Seung Young; Ryu, Ho Geol

doi:10.3346/jkms.2019.34.e212

Cited by 4 publications

(5 citation statements)

References 41 publications

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“…However, there is a paucity in published studies on how hypertension affects clinical outcome in patients with sepsis. We found that hypertension had lower in-hospital mortality than other comorbidities, in line with previous ICU studies [ 19 , 20 ]. A retrospective study demonstrated that patients with septic shock and chronic hypertension achieved and maintained target mean arterial pressure (MAP) more quickly, but that faster target MAP attainment and maintenance did not translate into lower mortality [ 21 ].…”

Section: Discussionsupporting

confidence: 92%

“…Its prevalence exceeds 13% in the US [ 36 ] and 8.2% in Korea adult population [ 37 ]. Moreover, observational studies reported a 10% to 13.3% prevalence in ICU patients [ 19 , 38 ], similar to the 13.7% in our patients with sepsis. The majority of studies reported variable in-hospital mortality rates for patients with CKD ranging from 28% to 45% [ 9 , 10 ], which is in line with our results, at 28%.…”

Section: Discussionsupporting

confidence: 89%

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Prevalence and outcomes of chronic comorbid conditions in patients with sepsis in Korea: a nationwide cohort study from 2011 to 2016

Kang,

Choi,

Jang

et al. 2024

BMC Infect Dis

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Background Chronic comorbid conditions are common in patients with sepsis and may affect the outcomes. This study aimed to evaluate the prevalence and outcomes of common comorbidities in patients with sepsis. Methods We conducted a nationwide retrospective cohort study. Using data from the National Health Insurance Service of Korea. Adult patients (age ≥ 18 years) who were hospitalized in tertiary or general hospitals with a diagnosis of sepsis between 2011 and 2016 were analyzed. After screening of all International Classification of Diseases 10th revision codes for comorbidities, we identified hypertension, diabetes mellitus (DM), liver cirrhosis (LC), chronic kidney disease (CKD), and malignancy as prevalent comorbidities. Results Overall, 373,539 patients diagnosed with sepsis were hospitalized in Korea between 2011 and 2016. Among them, 46.7% had hypertension, 23.6% had DM, 7.4% had LC, 13.7% had CKD, and 30.7% had malignancy. In-hospital mortality rates for patients with hypertension, DM, LC, CKD, and malignancy were 25.5%, 25.2%, 34.5%, 28.0%, and 33.3%, respectively, showing a decreasing trend over time (P < 0.001). After adjusting for baseline characteristics, male sex, older age, use of mechanical ventilation, and continuous renal replacement therapy, LC, CKD, and malignancy were significantly associated with in-hospital mortality. Conclusions Hypertension is the most prevalent comorbidity in patients with sepsis, and it is associated with an increased survival rate. Additionally, liver cirrhosis, chronic kidney disease, and malignancy result in higher mortality rates than hypertension and DM, and are significant risk factors for in-hospital mortality in patients with sepsis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Prevalence and outcomes of chronic comorbid conditions in patients with sepsis in Korea: a nationwide cohort study from 2011 to 2016

Kang,

Choi,

Jang

et al. 2024

BMC Infect Dis

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“…As mentioned earlier, hospitals with higher ED levels and more staffed beds cared for more critically ill patients. Increasing evidence suggests that hospitals with higher patient volumes achieve better patient outcomes across various medical conditions and surgical procedures [ 60 – 63 ]. Our findings may reflect this “volume-outcome relationship”.…”

Section: Discussionmentioning

confidence: 99%

Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea

et al. 2022

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Background Prolonged emergency department length of stay (EDLOS) in critically ill patients leads to increased mortality. This nationwide study investigated patient and hospital characteristics associated with prolonged EDLOS and in-hospital mortality in adult patients admitted from the emergency department (ED) to the intensive care unit (ICU). Methods We conducted a retrospective cohort study using data from the National Emergency Department Information System. Prolonged EDLOS was defined as an EDLOS of ≥ 6 h. We constructed multivariate logistic regression models of patient and hospital variables as predictors of prolonged EDLOS and in-hospital mortality. Results Between 2016 and 2019, 657,622 adult patients were admitted to the ICU from the ED, representing 2.4% of all ED presentations. The median EDLOS of the overall study population was 3.3 h (interquartile range, 1.9–6.1 h) and 25.3% of patients had a prolonged EDLOS. Patient characteristics associated with prolonged EDLOS included night-time ED presentation and Charlson comorbidity index (CCI) score of 1 or higher. Hospital characteristics associated with prolonged EDLOS included a greater number of staffed beds and a higher ED level. Prolonged EDLOS was associated with in-hospital mortality after adjustment for selected confounders (adjusted odds ratio: 1.18, 95% confidence interval: 1.16–1.20). Patient characteristics associated with in-hospital mortality included age ≥ 65 years, transferred-in, artificially ventilated in the ED, assignment of initial triage to more urgency, and CCI score of 1 or higher. Hospital characteristics associated with in-hospital mortality included a lesser number of staffed beds and a lower ED level. Conclusions In this nationwide study, 25.3% of adult patients admitted to the ICU from the ED had a prolonged EDLOS, which in turn was significantly associated with an increased in-hospital mortality risk. Hospital characteristics, including the number of staffed beds and the ED level, were associated with prolonged EDLOS and in-hospital mortality.

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“…Tables 1 - 3 summarized studies that evaluated the impact of ICU case volume on patient outcome in general critically ill patients ( Table 1 ) [ 10 - 13 ], sepsis and septic shock patients ( Table 2 ) [ 14 - 19 ], and mechanically ventilated patients ( Table 3 ) [ 20 - 26 ].…”

Section: The Impact Of Institutional Case Volume On Various Criticall...mentioning

confidence: 99%

“…The in-hospital mortality rates for the low-, medium-, and high-volume groups were 39.2%, 35.8%, and 32.6%, respectively (P<0.01). After adjusting for covariates, the low-volume centers exhibited a significantly higher mortality rate than the high-volume centers (OR, 1.33; 95% CI, 1.30–1.37; P<0.001) [ 26 ]. A similar inverse relationship between case volume and long-term mortality was observed when comparing 5-year mortality rates between low- and high-volume centers (OR, 1.26; 95% CI, 1.20–1.31; P<0.001).…”

Section: The Impact Of Institutional Case Volume On Various Criticall...mentioning

confidence: 99%

Impact of institutional case volume on intensive care unit mortality

Kang

Ryu²

2023

ACC

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The primary aim of this review is to explore current knowledge on the relationship between institutional intensive care unit (ICU) patient volume and patient outcomes. Studies indicate that a higher institutional ICU patient volume is positively correlated with patient survival. Although the exact mechanism underlying this association remains unclear, several studies have proposed that the cumulative experience of physicians and selective referral between institutions may play a role. The overall ICU mortality rate in Korea is relatively high compared to other developed countries. A distinctive aspect of critical care in Korea is the existence of significant disparities in the quality of care and services provided across regions and hospitals. Addressing these disparities and optimizing the management of critically ill patients necessitates thoroughly trained intensivists who are well-versed in the latest clinical practice guidelines. A fully functioning unit with adequate patient throughput is also essential for maintaining consistent and reliable quality of patient care. However, the positive impact of ICU volume on mortality outcomes is also linked to complex organizational factors, such as multidisciplinary rounds, nurse staffing and education, the presence of a clinical pharmacist, care protocols for weaning and sedation, and a culture of teamwork and communication. Despite some inconsistencies in the association between ICU patient volume and patient outcomes, which are thought to arise from differences in healthcare systems, ICU case volume significantly affects patient outcomes and should be taken into account when formulating related healthcare policies.

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Effect of Institutional Case Volume on In-Hospital and Long-Term Mortality in Critically Ill Patients Requiring Mechanical Ventilation for 48 Hours or More

Cited by 4 publications

References 41 publications

Prevalence and outcomes of chronic comorbid conditions in patients with sepsis in Korea: a nationwide cohort study from 2011 to 2016

Prevalence and outcomes of chronic comorbid conditions in patients with sepsis in Korea: a nationwide cohort study from 2011 to 2016

Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea

Impact of institutional case volume on intensive care unit mortality

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